This paper presents specific guidelines, developed by the International Society of Geriatric Oncology (SIOG), for the treatment of localized and metastatic prostate cancer, specifically in older men.
Prostate cancer is predominantly a disease of older men (> 70 years). A systematic review of the literature revealed that besides the chronological age and disease status, a few other factors should be considered for the optimal management of older patients.
The SIOG guidelines provide recommendations for both localized and metastatic disease. In both cases, the individual general health status of the older patient plays a vital role in the optimal treatment decision.
The general health assessment includes the evaluation of the presence of other diseases (co-morbidities), how dependent the patient is on help in daily life (dependence status), and the nutritional status (weight loss estimation). Overall, the treatment decision carefully evaluates whether the general health status of the patient allows any intervention, or he is too frail to endure treatment, which in that case may be life threatening.
Patients with localized prostate cancer who are comparatively healthy (i.e. have no or only few, reversible health problems), should receive the same treatment as younger patients (i.e. any form of standard cancer treatment, so called curative treatment options, such as surgical removal of the prostate). In cases where the patient has some irreversible health problems, an alternative treatment route is suggested for localized prostate cancer (e.g. active surveillance; hormonal therapy in certain cases). For patients with terminal illness (based on the presence of major other health problems in addition to prostate cancer), symptomatic palliative (supportive) care is recommended.
As for patients with metastatic (spread) prostate cancer, here too, the assessment of the general health status is key to the recommended treatment. For relatively healthy patients with none or few treatable other health problems, the treatment recommendations are hormonal therapy followed by standard chemotherapy. For frail patients with serious age-related health problems, hormonal therapy followed by an adapted chemotherapy schedule is recommended. In terminally ill patients with major health impairments, symptomatic palliative care is recommended.
In summary, this paper provides clear management guidelines (in form of a “decision tree”) for the treatment of localized and metastatic prostate cancer in men 75 years or older.
Published By :
BJUI
Date :
Aug 01, 2010
